Heikal Noha, Mari Alessandra, Köglmeier Jutta
Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK.
Department of Pediatrics, Ospedale dei Bambini Vittore Buzzi, University of Milan, 20154 Milano, Italy.
Children (Basel). 2025 Jan 26;12(2):137. doi: 10.3390/children12020137.
Pneumatosis intestinalis (PI) is rare in childhood. The aetiology remains poorly understood. Our aim was to assess its associated risk factors and outcome.
Retrospective data collection of all children (>1 month of age) with radiological evidence of PI identified from 1991 to 2021 in a large children's hospital. Poor outcome was defined as loss of enteral autonomy, or death within one month of PI diagnosis.
A total of 31 patients (21 male, 67.7%) were included, with a median age of 5 years. The underlying diagnosis was heterogenous. Cerebral palsy and acute lymphocytic leukaemia (ALL) were most common (5/31 for each, 16.13%). A share of 12/31 (38.7%) developed PI 2-15 months post-bone marrow transplantation (BMT). Most patients (n = 15, 48.4%) had no pre-existing gastroenterological disorder. In the majority (11/31, 35.5%), PI was an incidental finding. Abdominal pain was the most common presentation in symptomatic children (7/31, 22.6%). All (31/31, 100%) were managed conservatively with gut rest and antibiotics, and 6/31 (19.4%) had a poor outcome (1/31 permanent feeding intolerance, 5/31 died). When comparing patients who did well (group 1) to those with a poor outcome (group 2), worse prognosis was associated with a lower platelet count ( = 0.016), raised CRP ( = 0.008), higher creatinine ( = 0.006), and higher urea ( = 0.013).
The overall prognosis of PI in childhood is good but associated with significant morbidity and mortality in a small number of patients. Our data suggest that lower platelet count, and higher urea, creatinine, and CRP levels might be risk factors.
小儿肠壁积气（PI）较为罕见。其病因仍了解甚少。我们的目的是评估其相关危险因素及预后。
对1991年至2021年在一家大型儿童医院确诊的所有有PI影像学证据的儿童（年龄>1个月）进行回顾性数据收集。不良预后定义为肠内自主性丧失，或在PI诊断后1个月内死亡。
共纳入31例患者（21例男性，占67.7%），中位年龄为5岁。潜在诊断多种多样。脑性瘫痪和急性淋巴细胞白血病（ALL）最为常见（各5/31，占16.13%）。12/31（38.7%）在骨髓移植（BMT）后2至15个月发生PI。大多数患者（n = 15，48.4%）既往无胃肠疾病。大多数（11/31，35.5%）PI为偶然发现。腹痛是有症状儿童最常见的表现（7/31，22.6%）。所有患者（31/31，100%）均采用肠道休息和抗生素进行保守治疗，6/31（19.4%）预后不良（1/31永久性喂养不耐受，5/31死亡）。将预后良好的患者（第1组）与预后不良的患者（第2组）进行比较时，预后较差与较低的血小板计数（P = 0.016）、升高的CRP（P = 0.008）、较高的肌酐（P = 0.006）和较高的尿素（P = 0.013）相关。
小儿PI的总体预后良好，但少数患者伴有显著的发病率和死亡率。我们的数据表明，较低的血小板计数以及较高的尿素、肌酐和CRP水平可能是危险因素。
